Flexible Anchors For Tissue Fixation

ABSTRACT

A method for securing an anchor to tissue includes positioning the anchor in an area of the tissue. The anchor can include a flexible first tubular member, a flexible second tubular member, and a first suture member. The first tubular member can include a first wall defining a first passage between first and second ends. The second tubular member can include a second wall defining a second passage between first and second ends. The first suture member can couple the first tubular member and the second tubular member. The first suture member can pass through the first wall and the first passage and the second wall and the second passage. The first tubular member and the second tubular member can engage each other and deform to form an anchoring mass upon tensioning the first suture member.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/177,153 filed on Jul. 6, 2011, which is a continuation-in-part of:(1.) U.S. patent application Ser. No. 13/111,564 filed on May 19, 2011,now U.S. Pat. No. 8,574,235 issued on Nov. 5, 2013; (2.) U.S. patentapplication Ser. No. 13/098,927 filed on May 2, 2011, which is acontinuation in part of U.S. patent application Ser. No. 12/196,398filed Aug. 22, 2008, now U.S. Pat. No. 7,959,650 issued on Jun. 14,2011; (3.) U.S. patent application Ser. No. 13/098,897 filed on May 2,2011, now U.S. Pat. No. 8,562,645 issued on Oct. 22, 2013; (4.) U.S.patent application Ser. No. 12/976,328 filed on Dec. 22, 2010, now U.S.Pat. No. 8,273,106 issued on Sep. 25, 2012, which is a continuation ofU.S. patent application Ser. No. 11/869,440 filed on Oct. 9, 2007, nowU.S. Pat. No. 7,857,830 issued on Dec. 28, 2010, which is acontinuation-in-part of U.S. patent application Ser. No. 11/347,661filed on Feb. 3, 2006, now U.S. Pat. No. 7,749,250 issued on Jul. 6,2010; (5.) U.S. patent application Ser. No. 12/938,902 filed on Nov. 3,2010, now U.S. Pat. No. 8,597,327 issued on Dec. 3, 2013; (6.) U.S.patent application Ser. No. 12/915,962 filed on Oct. 29, 2010, now U.S.Pat. No. 8,562,647 issued on Oct. 22, 2013; (7.) U.S. patent applicationSer. No. 12/570,854 filed on Sep. 30, 2009, now U.S. Pat. No. 8,303,604issued on Nov. 6, 2012, which is a continuation-in-part of U.S. patentapplication Ser. No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat.No. 7,909,851, issued on Mar. 22, 2011; (8.) U.S. patent applicationSer. No. 12/489,168 filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113issued on Jan. 29, 2013, which is a continuation-in-part of U.S. patentapplication Ser. No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No.8,088,130 issued on Jan. 3, 2012, which is a continuation-in-part ofU.S. patent application Ser. No. 12/196,410 filed on Aug. 22, 2008, nowU.S. Pat. No. 8,118,836 issued on Feb. 21, 2012; (9.) U.S. patentapplication Ser. No. 12/489,181 filed on Jun. 22, 2009, now U.S. Pat.No. 8,298,262 issued on Oct. 30, 2012, which is a continuation-in-partof (a) U.S. patent application Ser. No. 12/014,399 filed on Jan. 15,2008, now U.S. Pat. No. 7,909,851 issued on Mar. 22, 2011; (b) U.S.patent application Ser. No. 12/014,340 filed on Jan. 15, 2008, now U.S.Pat. No. 7,905,904 issued on Mar. 15, 2011; and (c) U.S. patentapplication Ser. No. 11/935,681 filed on Nov. 6, 2007, now U.S. Pat. No.7,905,903 issued on Mar. 15, 2011; (10.) U.S. patent application Ser.No. 11/504,882 filed on Aug. 16, 2006, which is a continuation-in-partof U.S. patent application Ser. No. 11/408,282 filed on Apr. 20, 2006,which is now abandoned.

The entire disclosures of each of the above applications areincorporated herein by reference.

FIELD

The present disclosure relates to surgical methods and apparatuses, andgenerally for attaching tissue to bone.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

Tears caused by trauma or disease in soft tissue, such as cartilage,ligament, or muscle, can be repaired by suturing. Various repairtechniques and devices have been developed for facilitating suturingthat include the use of rigid, non-flexible anchors and that areeffective for their intended purposes. Nevertheless, there is still aneed in the relevant art for tissue repair techniques and associateddevices for facilitating suturing without requiring the use of rigidanchors.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

In one form, the present disclosure provides an anchor for securingtissue to bone that can include a flexible first tubular member, aflexible second tubular member, and a first suture member. The firsttubular member can include a first wall defining a first passage betweenfirst and second ends. The second tubular member can include a secondwall defining a second passage between first and second ends. The firstsuture member can couple the first tubular member and the second tubularmember. The first suture member can pass through the first wall and thefirst passage and the second wall and the second passage. The firsttubular member and the second tubular member can engage each other anddeform to form an anchoring mass upon tensioning the first suturemember.

In various aspects, the present disclosure also provides an anchor forsecuring tissue to bone that can include a flexible first tubular memberand a first suture member. The first tubular member can include a walldefining a passage extending along an axis between first and secondends. The first suture member can pass through the wall and the passagea plurality of times to create a plurality of intersecting sections andat least one loop section coupling the plurality of intersectingsections. The intersecting sections can extend between a first aperturein the wall through which the first suture member enters the passage anda second aperture in the wall through which the first suture memberexits the passage. At least two of the plurality of intersectingsections can move towards each other and deform a section extendingbetween them upon tensioning the first suture member.

In other aspects, the present disclosure also provides an anchor forsecuring tissue to bone that can include a flexible first elongatemember having first and second ends, a flexible second elongate memberhaving first and second ends, and a suture member. The suture member cancouple the first elongate member and the second elongate member. Thesuture member can pass through both the first elongate member and thesecond elongate member a plurality of times. The first elongate memberand the second elongate member can engage each other and can deform toform an anchoring mass upon tensioning the suture member.

In another form, the present disclosure provides a method of preparingan anchor for securing soft tissue to bone. The method can include: (i)providing a flexible first tubular member including a first walldefining a first passage between first and second ends, (ii) providing aflexible second tubular member including a second wall defining a secondpassage between first and second ends, and (iii) passing a suture memberthrough the first wall and the first passage and the second wall and thesecond passage to couple the first tubular member and the second tubularmember.

In various aspects, the present disclosure also provides a method ofsecuring a tissue to a bone that can include determining an area of thebone to couple an anchor. The anchor can include: (i) a flexible firsttubular member including a first wall defining a first passage betweenfirst and second ends, (ii) a flexible second tubular member including asecond wall defining a second passage between first and second ends, and(iii) a first suture member passing through the first wall and the firstpassage and the second wall and the second passage. The method canfurther include positioning the anchor at a position relative to thearea, and tensioning the first suture member until the first tubularmember engages the second tubular member, and the first flexible tubularmember and the second tubular member deform to form an anchoring mass.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a perspective view illustrating an exemplary anchor forsecuring tissue to bone according to the present disclosure;

FIG. 2A is a fragmentary cross-sectional view illustrating an exemplarymethod of positioning an anchor within a bone according to the presentdisclosure;

FIG. 2B is a fragmentary side elevation view illustrating an exemplaryinsertion instrument according to the present disclosure;

FIG. 3 is a fragmentary cross-sectional view illustrating an exemplarymethod of engaging an anchor with a cancellous bone tissue according tothe present disclosure;

FIG. 4 is a perspective view illustrating another anchor for securingtissue to bone according to the present disclosure;

FIG. 5 is a perspective view illustrating another anchor for securingtissue to bone according to the present disclosure;

FIG. 6 is a perspective view illustrating another anchor for securingtissue to bone according to the present disclosure;

FIG. 7 is a side elevation view illustrating another anchor for securingtissue to bone according to the present disclosure;

FIG. 8 is a perspective view illustrating another anchor for securingtissue to bone according to the present disclosure;

FIG. 9 is a fragmentary cross-sectional view illustrating an exemplarymethod of engaging the anchor shown in FIG. 8 with a tissue according tothe present disclosure;

FIG. 10 is a fragmentary cross-sectional view illustrating an exemplarymethod of engaging the anchor shown in FIG. 8 with a cortical bonetissue according to the present disclosure;

FIG. 11 is a side elevation view illustrating another anchor forsecuring tissue to bone according to the present disclosure;

FIG. 12 is a perspective view illustrating another anchor for securingtissue to bone according to the present disclosure; and

FIG. 13 is a fragmentary side elevation view illustrating an exemplarymethod of engaging the anchor of FIG. 12 with a cancellous bone tissueaccording to the present disclosure.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, its application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate corresponding parts throughout the severalviews of the drawings.

The present disclosure provides various anchors for securing a tissue toa bone, as well as methods of assembling the anchors, and methods ofsecuring a tissue to a bone using the anchors. It will be appreciatedthat the anchors and methods can be used for various therapeuticpurposes including, but not limited to, suturing repairs of tears causedby trauma or disease in soft tissue, such as cartilage, ligament, ormuscle. For example, the anchors and methods can be used to attach softtissue to bone. It will be further appreciated that the anchors andmethods are not limited to attaching soft tissue to bone and can also beused to attach bone to bone. Moreover, while the anchors are illustratedas being positioned within a bone in various examples, the anchors canbe embedded within or engage an outer surface of the bone or anadjoining tissue as illustrated in other examples.

With particular reference to FIG. 1, a perspective view illustrates anexemplary anchor 10 that can be used for securing a tissue to a boneaccording to the present disclosure. In various aspects, the tissue canbe a soft tissue or bone. The anchor 10 can be made from variousresorbable and non-resorbable bio-compatible materials including, butnot limited to, polymeric materials such as polyester, polyethylene, andpolypropylene, and natural materials such as cotton and silk. In variousaspects, one or more components of the anchor 10 can include biologicalor biocompatible coatings, and also can be soaked in platelets and otherbiologics.

The anchor 10 can include flexible tubular members 12, 14 and a flexiblesuture member 16. The tubular members 12, 14 can have properties thatallow the tubular members 12, 14 to change shape. For example, thetubular members 12, 14 can have properties that make them flexible,foldable, compressible, stretchable, elastic, deformable, flaccid, limp,soft, spongy or otherwise capable of changing shape. The tubular members12, 14 can be hollow elongated structures having a sleeve or tubularconfiguration. In alternate constructions, the anchor 10 can includesubstantially solid flexible elongate members in place of the tubularmembers 12, 14. In various aspects, the elongate members can have asubstantially flat, planar, or ribbon-like shape formed, for example,from a flat sponge-like material or a piece of woven fabric which can bepierced to allow the suture member 16 to pass through. In various otheraspects, the elongate members can also have various cross-sectionalshapes. For example, the shapes can be circular, polygonal, square,rectangular, etc.

The tubular member 12 can include a wall 20 defining an elongatedpassage 22 extending along an axis 24 between ends 26, 28. The passage22 can have a diameter or size configured to allow the suture member 16to pass through the tubular member 12 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture member16 when the suture member 16 is tensioned. The tubular member 12 canfurther include one or more apertures disposed between the ends 26, 28for passing the suture member 16 through the wall 20. For example, thetubular member 12 can have six apertures 30, 32, 34, 36, 38, 40 asillustrated by the present example. The apertures 30, 32, 34, 36, 38, 40can be spaced apart in a line as shown, and in various aspects,circumferentially spaced apart.

The tubular member 14 can include a wall 50 defining a passage 52extending along an axis 54 between ends 56, 58. The passage 52 can havea diameter or size configured to allow the suture member 16 to passthrough the tubular member 14 and to provide a locking feature throughfrictional and/or mechanical engagement with the suture member 16 whenthe suture member 16 is tensioned. The tubular member 14 can furtherinclude one or more apertures disposed between the ends 56, 58 forpassing the suture member 16 through the wall 50. For example, thetubular member 14 can have four apertures 60, 62, 64, 66.

The suture member 16 can be a suture thread of a suitable length betweenends 70, 72 for coupling the tubular members 12, 14 in a desired mannerand for coupling the anchor 10 to the tissue by, for example, a suturestitch or other suitable coupling member.

With continued reference to FIG. 1, an exemplary method of assembling orforming the anchor 10 will now be described. The method includescoupling the tubular member 12 and the tubular member 14 using thesuture member 16. The anchor 10 can be assembled or formed and thetubular members 12, 14 coupled by passing the suture member 16 throughthe walls 20, 50 and the passages 22, 52 in a predetermined manner.According to the present example, the suture member 16 can be passedthrough the walls 20, 50 to create two compression loops 74, 76 thatcouple the tubular members 12, 14 in a substantially parallelarrangement. The loop 74 can couple the tubular members 12, 14 near theends 26, 56 and the loop 76 can couple the tubular members 12, 14 nearthe ends 28, 58.

To create the loops 74, 76, the end 70 of the suture member 16 can bepassed through the aperture 30, guided through the passage 22, andpassed out through the aperture 32. Next, the end 70 can be passedthrough the aperture 62, guided through the passage 52, and passedthrough the aperture 60. Next, the end 70 can be passed through theaperture 34, guided through the passage 22, and passed through theaperture 36, creating the loop 74. Next, the suture member 16 can bepassed through the aperture 66, guided through the passage 52, andpassed through the aperture 64. Next, the suture member 16 can be passedthrough the aperture 38, guided through the passage 22, and passedthrough the aperture 40, creating the loop 76.

Once the loops 74, 76 are created, the ends 70, 72 can be pulled toadjust a diameter or size of the loops 74, 76 and thereby bring thetubular members 12, 14 into a desired relationship in an untensionedstate suitable for positioning the anchor 10 relative to the bone. Invarious aspects, the ends 70, 72 can be pulled such that a predeterminedspacing 78 between the tubular members 12, 14 is achieved and thetubular members 12, 14 extend generally parallel to each other. Invarious aspects, the spacing 78 and an angle between the tubular members12, 14 can vary so that a predetermined relationship is achieved and theanchor 10 has a desired first shape in an untensioned state wheninitially positioned relative to the bone. For example, the spacing 78can be such that one or both of the tubular members 12, 14 can bedeformed or folded in half without engaging each other in theuntensioned state. In this way, a width of the anchor 10 in anuntensioned state and a corresponding hole size can be minimized. Thespacing 78 can be minimized to minimize insertion depth.

The suture member 16 can be passed through the walls 20, 50 and thepassages 22, 52 in the foregoing manner to create a series ofintersecting sections 80, 82, 84 and sections 86, 88 in the tubularmember 12 and the tubular member 14, respectively. The intersectingsections 80, 82, 84 are sections where the suture member 16 intersectsthe tubular member 12, and the intersecting sections 86, 88 are sectionswhere the suture member 16 intersects the tubular member 14. Theintersecting sections 80, 82, 84, 86, 88 can be defined between therespective apertures 30, 32, 34, 36, 38, 60, 62, 64, 66. As one example,the intersecting section 80 can be defined between the aperture 30 wherethe suture member 16 enters the passage 22 through the wall 20 and theaperture 32 where the suture member 16 exits the passage 22 through thewall 20.

The intersecting sections 80, 82, 84, 86, 88 can be drawn towards eachother and into engagement by pulling on the ends 70, 72 of the suturemember 16 to create tension within the suture member 16. Tension in thesuture member 16 can compress and/or deform the intersecting sections80, 82, 84, 86, 88 individually, and together. Tension in the suturemember 16 can further compress and/or deform sections of the tubularmembers 12, 14 extending between the intersecting sections 80, 82, 84and sections between the intersecting sections 86, 88. In variousaspects, a number and location of the intersecting sections 80, 82, 84,86, 88 can vary and the intersecting sections 80, 82, 84, 86, 88 canhave a predetermined relationship so the anchor 10 deforms between thefirst shape and a second shape when positioned relative to the bone andtensioned. The sections extending between the intersecting sections 80,82, 84 and the sections extending between the intersecting sections 86,88 can define portions of the anchoring mass that provide additionalfrictional and/or mechanical resistance for securing the anchor 10relative to the bone.

In an exemplary construction, the tubular members 12, 14 can be madefrom a No. 5 size braided suture and the suture member 16 can be madefrom a No. 1 size suture. It will be appreciated that the presentdisclosure is not limited to such a construction, and that constructionsmade from other suture sizes are contemplated. The apertures 30, 32, 34,36, 38, 40 and the apertures 60, 62, 64, 66 can be defined by voidsbetween two or more fibers of the woven fabric of the braided sutureforming the tubular members 12, 14. In this way, the apertures 30, 32,34, 36, 38, 40, 60, 62, 64, 66 can be present without breaking theweave. When coupled by the suture member 16 in an untensioned state, thespacing 78 between the tubular members 12, 14 can be around 0.4 inches.According to the foregoing construction, the anchor 10 can provide pullout forces of between around twenty-five pounds (25 lbs) and thirty-onepounds (31 lbs) and, more particularly, around twenty-eight pounds (28lbs). Thus, it will be appreciated that the anchor 10 according to thepresent disclosure can provide pull out forces that are greater thanother conventional flexible anchors.

An overall length of the tubular member 12 can be around 0.74 inches.The apertures 30, 32, 34, 36, 38, 40 are disposed along the length ofthe tubular member 12 in a symmetrical arrangement about a line ofsymmetry located midway along the length located at around 0.37 inchesfrom the ends 26, 28. Centers of the apertures 30, 32, 34 are spacedapart from the end 26 by around 0.06 inches, 0.21 inches, and 0.31inches, respectively. Centers of the apertures 36, 38, 40 are spacedapart from the end 28 by around 0.31 inches, 0.21 inches, and 0.06inches, respectively. According to the foregoing spacing, theintersecting sections 80, 82, 84 have lengths of around 0.15 inches,0.12 inches, and 0.15 inches, respectively.

An overall length of the tubular member 14 can be around 1.10 inches.The apertures 60, 62, 64, 66 are disposed along the length of thetubular member 14 in a symmetrical arrangement about a line of symmetrylocated midway along the length located at around 0.55 inches from theends 56, 58. Centers of the apertures 60, 62 are spaced apart from theend 56 by around 0.06 inches and 0.25 inches, respectively. Centers ofthe apertures 64, 66 are spaced apart from the end 58 by around 0.25inches and 0.06 inches, respectively. Accordingly, the intersectingsections 86, 88 each have a length of around 0.19 inches. It will beappreciated that the present disclosure is not limited to the foregoingdimensions, and that other dimensional features and relationships arecontemplated.

With additional reference to FIGS. 1-3, an exemplary method of securingthe anchor 10 with a bone 100 according to the present disclosure willnow be described. The method can include securing the anchor 10 within aregion of cancellous bone tissue 102 adjacent a region of cortical bonetissue 104. The method can be used during a surgical procedure forcoupling adjoining anatomy such as a soft tissue 106 to the bone 100, orother bone. For example, the method can be used during a surgicalprocedure for repairing a tear in the soft tissue 106 to be attached tothe bone 100. More specifically, the method can be used in labralrepairs, rotator cuff repairs, and anterior cruciate ligament (ACL)reconstructions.

First, an area 110 of the bone 100 for securing the anchor 10 isselected and an aperture 112 is formed in the area 110. The aperture 112can be formed by boring into the bone 100 through the cortical bonetissue 104 into the cancellous bone tissue 102. Next, the anchor 10 canbe loaded onto an insertion instrument 114 configured to insert andposition the anchor 10 at a predetermined position relative to theaperture 112. As best seen in FIG. 2B, an exemplary insertion instrument114 can include a fork 116 configured to pass between the tubularmembers 12, 14 and engage the tubular member 14. The anchor 10 can beloaded onto the insertion instrument 114 by coupling the tubular member14 to the fork 116. The insertion instrument 114 can optionally includea fork 117 as shown that is configured to engage the tubular member 12and to hold the tubular members 12, 14 in a desired relationship whenpositioned within the aperture 112.

With the anchor 10 loaded on to the insertion instrument 114, the loadedinsertion instrument 114 can be coupled to a guide (not shown) andadvanced within the aperture 112. For example, the insertion instrument114 carrying the anchor 10 can be inserted into a cannulated guidetypically used for arthroscopic surgery. The insertion instrument 114can be advanced until the anchor 10 is positioned in a region of thecancellous bone tissue 102 a predetermined distance below the corticalbone tissue 104 as shown in FIG. 2A. With the anchor 10 thus positioned,the insertion instrument 114, and more particularly the fork 116, can beuncoupled from the anchor 10 by moving and/or withdrawing the insertioninstrument 114 in an axial direction relative to the aperture 112. In anuntensioned state, the anchor 10 can have a first configuration 120 orshape as shown in FIG. 2A and can frictionally and/or mechanicallyengage the cancellous bone tissue 102.

With the insertion instrument 114 uncoupled, the tubular members 12, 14can be drawn into engagement to create an anchoring mass 122 that cansecure the anchor 10 relative to the bone 100 substantially at thepredetermined position as shown in FIG. 3. The anchoring mass 122 canhave a second configuration 124 or shape that is different than thefirst configuration 120. The tubular members 12, 14 can be drawn towardseach other and into engagement by pulling on the ends 70, 72 of thesuture member 16 in a direction that is generally coaxial with and awayfrom the aperture 112. In various aspects, the ends 56, 58 of thetubular member 14 can frictionally and/or mechanically engage a wall ofthe aperture 112. The engagement of the ends 56, 58 can retain thetubular member 14 in place relative to the aperture 112 as the tubularmember 12 is drawn towards the tubular member 14 and into engagement. Inthis way, the tubular member 14 can retain the anchor 10 substantiallyat the same predetermined position as the anchor 10 is initiallypositioned as the suture member 16 is tensioned. In various aspects, theends 26, 28 of the tubular member 12 do not catch on the wall of theaperture 112 as the tubular member 12 is drawn towards the tubularmember 14 deeper in the aperture 112. In other aspects, as the tubularmembers 12, 14 are drawn into engagement with one another, theintersecting sections 80, 82, 84 of the tubular member 12 can be drawntowards and into engagement with the intersecting sections 86, 88. Instill other aspects, the suture member 16 is passed through the tubularmembers 12, 14 so that sections of the tubular members 12, 14, includingone or more of the intersecting sections 80, 82, 84, 86, 88 are forcedin a direction of the wall of the aperture 112.

During the engagement, sections of the tubular members 12, 14 cancompress, collapse, buckle, fold, bunch, expand, or otherwise deform toform the anchoring mass 122. In various aspects, the secondconfiguration 124 can include an overall width that is greater than thatof the first configuration 120 and a diameter or width of the aperture112. By having a greater width, the second configuration 124 can expandinto the cancellous bone tissue 102, beyond the width of the aperture112. In this way, the second configuration 124 can provide a mechanicallocking feature that secures the anchor 10 relative to the cancellousbone tissue 102. In various other aspects, the anchoring mass 122 canengage and lock against a ledge 126 defined by the cortical bone tissue.

With the anchor 10 thus set, remaining portions of the suture member 16can be coupled to the soft tissue 106 and/or other surrounding anatomy.The suture member 16 can be coupled to the soft tissue 106 using adesired suturing technique for performing the repair. The suturingtechnique can include attaching the suture member 16 to another anchorand engaging the anchor with the soft tissue 106. The suturing techniquecan include knotting, and other suture coupling techniques. In variousaspects, the suture member 16 can form various parts of a self-locking,adjustable loop construction such as those described in commonlyassigned U.S. Pat. Nos. 7,658,751 and 7,601,165, the entire disclosuresof which are incorporated by reference herein. For example, one or boththe ends 70, 72 of the suture member 16 can form one or more loops ofthe construct. Alternately or additionally, one or both the ends 70, 72can provide a tubular construct through which one or more loops ofanother suture pass.

With particular reference to FIG. 4 a perspective view illustratesanother anchor 200 for securing soft tissue to bone according to thepresent disclosure. The anchor 200 can include flexible tubular members212, 214 and suture members 216, 218. The anchor 200 illustrates analternate configuration according to the present disclosure. The anchor200 is similar to the anchor 10, except that the two suture members areused to couple and deform two soft anchoring members.

The tubular member 212 can include a wall 220 defining a passage 222extending along an axis 224 between ends 226, 228. The passage 222 canhave a diameter or size configured to allow the suture members 216, 218to pass through the tubular member 212 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture members216, 218 when one or both of the suture members 216, 218 are tensioned.The tubular member 212 can have eight apertures 230, 232, 234, 236, 238,240, 242, 244. The apertures 230, 234, 240, 244 can be spaced apartalong a first line as shown, and the apertures 232, 236, 238, 242 can bespaced apart along a second line circumferentially spaced apart from thefirst line.

The tubular member 214 can include a wall 250 defining a passage 252extending along an axis 254 between ends 256, 258. The passage 252 canhave a diameter or size configured to allow the suture members 216, 218to pass through the tubular member 214 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture members216, 218 when one or both of the suture members 216, 218 are tensioned.The tubular member 214 can further include four apertures 260, 262, 264,266.

The suture members 216, 218 can be suture threads of suitable lengthsbetween ends 270, 272 and ends 274, 276 for coupling the tubular members212, 214 in a desired manner and for coupling the anchor 200 to the softtissue by, for example, a suture stitch or other suitable couplingmember.

The suture member 216 can be passed through the walls 220, 250 and thepassages 222, 252 to create a first loop 280 coupling the ends 226, 256of the tubular members 212, 214, respectively. The suture member 216 canfurther create a series of intersecting sections 282, 284 and anintersecting section 286 in the tubular member 212 and the tubularmember 214, respectively. The suture member 218 can be passed throughthe walls 220, 250 and the passages 222, 252 to create a second loop 290coupling the ends 228, 258 of the tubular members 212, 214,respectively. The suture member 216 can further create a series ofintersecting sections 292, 294 and an intersecting section 296 in thetubular member 212 and the tubular member 214, respectively.

With particular reference to FIG. 5, a perspective view illustratesanother anchor 300 for securing soft tissue to bone according to thepresent disclosure. The anchor 300 can include flexible tubular members312, 314 and suture members 316, 318. The anchor 300 illustrates analternate configuration according to the present disclosure. The anchor300 is similar to the anchor 200, except that only one of the two suturemembers is used to couple and deform two soft anchoring members, whilethe second suture member is used to deform one of the two soft anchoringmembers. Additionally, the two suture members overlap in at least oneintersecting section. The anchor 300 can provide an additional featurethat multiple suture members can be separately employed to couple thetwo soft anchoring members and to individually deform the two softanchoring members.

The tubular member 312 can include a wall 320 defining a passage 322extending along an axis 324 between ends 326, 328. The passage 322 canhave a diameter or size configured to allow the suture members 316, 318to pass together through a section of the tubular member 312 and toprovide a locking feature through frictional and/or mechanicalengagement with the suture members 316, 318 when one or both of thesuture members 316, 318 are tensioned. The tubular member 312 can haveeight apertures 330, 332, 334, 336, 338, 340, 342, 344. The apertures330, 334, 340, 344 can be spaced apart along a first line as shown, andthe apertures 332, 336, 338, 342 can be spaced apart along a second linecircumferentially spaced apart from the first line.

The tubular member 314 can include a wall 350 defining a passage 352extending along an axis 354 between ends 356, 358. The passage 352 canhave a diameter or size configured to allow the suture member 316 aloneto pass through the tubular member 314 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture member316 when the suture member 316 is tensioned. The tubular member 314 canfurther include four apertures 360, 362, 364, 366.

The suture members 316, 318 can be suture threads of suitable lengthsbetween ends 370, 372 and ends 374, 376 for coupling the tubular members312, 314 in a desired manner and for coupling the anchor 300 to the softtissue by, for example, a suture stitch or other suitable couplingmember.

The suture member 316 can be passed through the walls 320, 350 and thepassages 322, 352 to create two loops 380, 382 that can couple the ends326, 356 and the ends 328, 358 of the tubular members 312, 314,respectively. The suture member 316 can be passed through the walls 320,350 and the passages 322, 352 to create a series of intersectingsections 384, 386, 388 and sections 390, 392 in the tubular member 312and the tubular member 314, respectively. The suture member 318 can bepassed through the wall 320 and the passage 222 to create anintersecting section 394 that overlaps with the intersecting section386. In various aspects, the suture 318 can provide a second strand ofsuture to secure the anchor 300 to soft tissue. The anchor 300 can beimplanted or secured within a bone in a manner similar to that of theanchor 10.

With particular reference to FIG. 6, a perspective view illustratesanother anchor 400 for securing soft tissue to bone according to thepresent disclosure. The anchor 400 is an example of a flexible anchorconfiguration for creating an anchoring mass that can be constructed bycoupling a single flexible tubular member and a single suture. Theanchor 400 can have a configuration similar to the configuration 124 ofthe second anchoring mass 122 created by the anchor 10. It will beappreciated that the anchor 400 can be coupled with a second flexibletubular member incorporating features of, for example, the anchor 10,the anchor 200, and the anchor 300. The anchor 400 can include aflexible tubular member 402 and a suture member 404.

The tubular member 402 can include a wall 410 defining a passage 412extending along an axis 414 between ends 416, 418. The passage 412 canhave a diameter or size configured to allow the suture member 404 topass through the tubular member 402 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture member404 when the suture member 404 is tensioned. The tubular member 402 canfurther include one or more apertures disposed between the ends 416, 418for passing the suture member 404 through the wall 410. For example, thetubular member 402 can have twelve apertures 420, 422, 424, 426, 428,430, 432, 434, 436, 438, 440, 442 as illustrated by the present example.

The apertures 420, 422, 424, 426, 428, 430, 432, 434, 436, 438, 440, 442can be spaced apart in a line as shown, and in various aspects,circumferentially spaced apart. The apertures 420, 422, 424, 426, 428,430, 432, 434, 436, 438, 440, 442 can have a symmetrical spacing about aline of symmetry 450, which can be located at around a midpoint betweenthe ends 416, 418 as shown. Accordingly, the apertures 420, 422, 424,426, 428, 430 can have a spacing relative to the line of symmetry 450that is the same as that of the apertures 442, 440, 438, 436, 434, 432,respectively.

The suture member 404 can be a suture thread of a suitable lengthbetween ends 452, 454 for passing through the tubular member 402 in adesired manner and for coupling the anchor 400 to the soft tissue by,for example, a suture stitch or other suitable coupling member. Thesuture member 404 can be passed through the wall 410 and the passage 412to create a series of nested loop sections 460, 462, nested loopsections 464, 466, a loop section 468, and intersecting sections 470,472, 474, 476, 478, 480. For example, the end 452 of the suture member404 can be passed through the apertures 420, 422, 430, 428, 424, 426,436, 438, 434, 432, 440, 442 in that order. When passed in the foregoingorder, the suture member 404 passes through the passage 412 between theapertures 420, 422, the apertures 424, 426, the apertures 436, 438, andthe apertures 440, 442 in a first direction relative to the axis 414indicated by arrows pointing to the right in FIG. 6. The suture member404 passes through the passage 412 between the apertures 430, 428 andthe apertures 434, 432 in a second direction relative to the axis 414opposite the first direction indicated by the arrows pointing to theleft in FIG. 6.

In an untensioned state, the anchor 400 can have a first shape as showngenerally in FIG. 6. While still in the untensioned state, the anchor400 can be deformed or folded about the line of symmetry 450 into anintermediate V-shape. The anchor 400 can be inserted within an apertureof a bone while in the intermediate V-shape. The anchor 400 can deformfrom the intermediate V-shape (or the first shape) to a second shapeforming an anchoring mass by tensioning the suture member 404. Tensionin the suture member 404 can be created by pulling on the ends 416, 418.Tension in the suture member 404 draws various intersecting sectionstowards each other and other intersecting sections away from each other,which deforms the tubular member 402. In various aspects, the anchoringmass can be secured within an aperture of a bone in a manner similar tothat illustrated by the anchor 10 in FIG. 3, or engage a surface of asoft tissue or bone in a similar manner to that illustrated by anotherexemplary anchor in FIG. 9. The anchor 400 can be secured using aninsertion instrument similar to the insertion instrument 114 and havinga single fork (e.g., fork 116). The insertion instrument can be coupledto the anchor 400 at a location where the anchor 400 is folded.

With particular reference to FIG. 7, a side elevation view illustratesanother anchor 500 for securing soft tissue to bone according to thepresent disclosure. The anchor 500 is another example of a flexibleanchor configuration for creating an anchoring mass that can beconstructed by coupling a single flexible tubular member and a singlesuture. The anchor 500 illustrates a feature in which the suture candeform the tubular member by twisting sections along a longitudinalaxis. The anchor 500 can include a flexible tubular member 502 and asuture member 504.

The tubular member 502 can include a wall 510 defining a passage 512extending along an axis 514 between ends 516, 518. The passage 512 canhave a diameter or size configured to allow the suture member 504 topass through the tubular member 502 and to provide a locking featurethrough frictional and/or mechanical engagement with the suture member504 when the suture member 504 is tensioned. The tubular member 502 canfurther include two or more apertures disposed on opposite sides betweenthe ends 516, 518 for passing the suture member 504 through the wall510. For example, the tubular member 502 can have four apertures 520,522, 524, 526 as illustrated by the present example.

The apertures 520, 524 can be disposed on a first side of the tubularmember 502, for example, a near side in FIG. 7. The apertures 522, 526can be disposed on a second side of the tubular member 502 opposite thefirst side, for example, a far side in FIG. 7. In various aspects, theapertures 520, 524 and the apertures 522, 526 can be diametricallyopposed (i.e., disposed at 180 degrees relative to each other) whenviewed along the axis 514.

In an untensioned state, the anchor 500 can have an accordion firstshape as shown generally in FIG. 7. While still in the untensionedstate, the anchor 500 can be deformed or folded into an intermediateV-shape. The intermediate V-shape can have a height in a first directionindicated by arrow 530 that is proportional to the length of the tubularmember 502. The intermediate V-shape can have a width in a seconddirection transverse to the first direction indicated by arrow 532 thatis proportional to the diameter of the diameter of the tubular member502. The anchor 500 can be inserted within an aperture of a bone whilein the intermediate V-shape. The anchor 500 can deform from theintermediate V-shape (or the first shape) to an accordion second shapeforming an anchoring mass by tensioning the suture member 504. Thesecond shape can be wider than the intermediate V-shape in the firstdirection indicated by arrow 532, and can be narrower than theintermediate V-shape in the second direction indicated by arrow 530.Tension in the suture member 504 can be created by pulling on the ends516, 518. Tension in the suture member 504 can draw the aperture 522towards the aperture 524 and twist and ball up a section of the tubularmember 502 between them.

In various aspects, the anchoring mass can be secured within an apertureof a bone in a manner similar to that illustrated by the anchor 10 inFIG. 3. For example, the anchor 500 can be positioned within a preformedbore so that the suture member 504 extends generally parallel to an axisof the bore and the tubular member 502 expands in a direction transverseto the axis when the suture member 504 is tensioned. Alternately, theanchoring mass can engage a surface of a soft tissue or a bone in asimilar manner to that illustrated by the exemplary anchor shown in FIG.9.

With particular reference to FIG. 8, a perspective view illustratesanother anchor 600 for securing soft tissue to bone according to thepresent disclosure. The anchor 600 is another example of a flexibleanchor configuration for creating an anchoring mass that can beconstructed by coupling a single flexible tubular member and a singlesuture. The anchor 600 illustrates a feature in which the suture candeform the tubular member by bending or folding sections in an alternatemanner.

The anchor 600 can include a flexible tubular member 602 and a suturemember 604. The tubular member 602 can include a wall 610 defining apassage 612 extending along an axis 614 between ends 616, 618. Thepassage 612 can have a diameter or size configured to allow the suturemember 604 to pass through the tubular member 602 and to provide alocking feature through frictional and/or mechanical engagement with thesuture member 604 when the suture member 604 is tensioned. The tubularmember 602 can further include, for example, six or more aperturesdisposed on opposite sides between the ends 616, 618 for passing thesuture member 604 through the wall 610. For example, the tubular member602 can have twelve apertures 620, 622, 624, 626, 628, 630, 632, 634,636, 638, 640, 642 as illustrated by the present example.

The apertures 620, 622, 624, 626, 628, 630 can be disposed in a firstline on a first side of the tubular member 602, for example, a top sidein FIG. 8. The apertures 632, 634, 636, 638, 640, 642 can be disposed ina second line on a second side of the tubular member 602 opposite thefirst side, for example, a bottom side in FIG. 8. In various aspects,the apertures 620, 622, 624, 626, 628, 630 and the apertures 632, 634,636, 638, 640, 642 can be diametrically opposed. A longitudinal spacingof the apertures 620, 622, 624, 626, 628, 630 can be equal to that ofthe apertures 632, 634, 636, 638, 640, 642. As one example, the aperture620 and the aperture 632 can be equally spaced from the first end 616 asshown.

The suture member 604 can be a suture thread of a suitable lengthbetween ends 644, 646 for passing through the tubular member 602 in adesired manner and for coupling the anchor 600 to the soft tissue by,for example, a suture stitch or other suitable coupling member. In anuntensioned state, the anchor 600 can have a first shape as showngenerally in FIG. 8. The anchor 600 can deform from the first shape toan accordion second shape as shown in FIGS. 9-10 forming an anchoringmass 648 by tensioning the suture member 604. Tension in the suturemember 604 can be created by pulling on the ends 644, 646. Tension inthe suture member 604 can draw the apertures 620, 622, the apertures634, 636, the apertures 624, 626, 638, 640, and the apertures 628, 630towards each other in an alternating fashion and create a series offolded sections 650, 652, 654, 656, 658 as shown in FIGS. 9-10.

With additional reference to FIGS. 8-9, an exemplary method of securingthe anchor 600 with a bone 660 according to the present disclosure willnow be described. The method can include securing the anchor 600 withina region of cancellous bone tissue 662 adjacent a region of corticalbone tissue 664. The method can be used during a surgical procedure forcoupling adjoining anatomy such as a soft tissue 668 to the bone 660.

The method can include positioning the anchor 600 in a bore 670 preparedin a selected area of the bone 660 and tensioning the suture member 602to set the anchoring mass 648 within the cancellous bone tissue 662 asshown in FIG. 9. With the anchoring mass 648 set, the ends 644, 646 canbe passed through the soft tissue 668 and can be coupled to the softtissue 668 by, for example, a suturing technique. When coupled, tensionin the suture member 602 can compress the soft tissue 668 against thebone 660.

With additional reference to FIGS. 8 and 10, an exemplary method ofengaging the anchor 600 with a bone 682 will now be described. It willbe appreciated that the following method is not limited to the anchor600, and can be used with other anchors according to the presentdisclosure. Generally, the method includes coupling the anchor 600 witha bone engaging surface 686. The method can include tensioning thesuture member 602 to create the anchoring mass 648 and passing the ends644, 646 through an aperture 688 formed in the bone 682 and coupling theends 644, 646 to an anchor (not shown) positioned within the aperture688. When coupled, tension in the suture member 602 can compress theanchor 600 against the bone engaging surface 686 of the bone 682. Theanchoring mass 648 resists pull through. The foregoing method ofcoupling the anchor 600 to the bone 682 can be used, for example, duringan ACL reconstruction surgery.

With particular reference to FIG. 11, a side elevation view illustratesanother anchor 700 for securing soft tissue to bone according to thepresent disclosure. The anchor 700 is another example of a flexibleanchor configuration for creating an anchoring mass that can beconstructed by coupling a single flexible tubular member and a singlesuture member. The anchor 700 illustrates a feature in which the suturemember can be wrapped around the flexible tubular member and can deformthe tubular member by twisting sections of the tubular member about itslongitudinal axis.

The anchor 700 can include a flexible tubular member 702 and a suturemember 704. The tubular member 702 can include a wall 710 defining apassage 712 extending along an axis 714 between ends 716, 718. Thepassage 712 can have a diameter or size configured to allow the suturemember 704 to pass through the tubular member 702 and to provide alocking feature through frictional and/or mechanical engagement with thesuture member 704 when the suture member 704 is tensioned. The tubularmember 702 can further include, for example, two or more aperturesdisposed on opposite sides between the ends 716, 718 for passing thesuture member 704 through the wall 710. For example, the tubular member702 can have four apertures 720, 722, 724, 726 as illustrated by thepresent example.

The apertures 720, 722 can be disposed in a first line on a first sideof the tubular member 702, for example, a bottom side in FIG. 11. Theapertures 724, 726 can be disposed in a second line on a second side ofthe tubular member 702 opposite the first side, for example, a top sidein FIG. 11. In various aspects, the apertures 720, 722 and the apertures724, 726 can be diametrically opposed when viewed along the axis 714. Alongitudinal spacing of the apertures 720, 722 can be different thanthat of the apertures 724, 726. As one example, the apertures 724, 726can be spaced further from the first end 716 than the apertures 720,722, respectively, as shown.

The suture member 704 can be a suture thread of a suitable lengthbetween ends 730, 732 for passing through the tubular member 702 in adesired manner and for coupling the anchor 700 to the soft tissue. Theanchor 700 can be assembled or formed by passing the suture member 704through the wall 710 and the passage 712 in the following manner. Theend 730 can be passed in the first side through the aperture 720, guidedthrough the passage 712, and out the second side through the aperture724. Next, the end 730 can be wrapped around the circumference of thetubular member 702 to the first side. The end 730 can then passed in thefirst side again through the aperture 722, guided through the passage712, and out the second side again through the aperture 726.

In an untensioned state, the anchor 700 can have a first shape as showngenerally in FIG. 11. The anchor 700 can deform from the first shape tosecond shape forming an anchoring mass by tensioning the suture member704. Tension in the suture member 704 can be created by pulling on theends 730, 732. Tension in the suture member 704 can draw the aperture722 towards the aperture 724 and twist a section of the tubular member702 between them.

With particular reference to FIG. 12, a perspective view illustratesanother anchor 800 for securing soft tissue to bone according to thepresent disclosure. The anchor 800 can include a flexible tubular member802 and a suture member 804. The tubular member 802 can include a wall810 defining a passage 812 extending along an axis 814 between ends 816,818. The passage 812 can have a diameter or size configured to allow thesuture member 804 to pass through the tubular member 802 when doubled upand to provide a locking feature through frictional and/or mechanicalengagement with the suture member 804 when the suture member 804 istensioned. The tubular member 802 can further include three or moreapertures disposed between the ends 816, 818 for passing the suturemember 804 through the wall 810. For example, the tubular member 802 canhave five apertures 820, 822, 824, 826, 828 as illustrated by thepresent example.

The apertures 820, 822, 824, 826, 828 can extend transverse to the axis814 through the wall 810 from a first side, for example, a side facingto the left in FIG. 12, through to a second side opposite the firstside, for example, a side facing to the right in FIG. 12. The apertures820, 822, 824 have a size configured to allow the suture member 804 topass through the wall 810 when doubled up as shown. The apertures 826,828 can be smaller than the apertures 820, 822, 824 and can have a sizeconfigured to allow the suture member 804 to pass through the wall 810.

The suture member 804 can be a suture thread of a suitable lengthbetween ends 830, 832 for passing through the tubular member 802 in adesired manner and for coupling the anchor 800 to the soft tissue by,for example, a suture stitch or other suitable coupling member.

The anchor 800 can be assembled or formed by passing the suture member804 through the wall 810 and the passage 812 in the following manner.The ends 830, 832 can be individually passed in the second side throughthe apertures 826, 828, respectively, guided through the passage 812,and passed out the first side through the apertures 826, 828,respectively. Passing the ends 830, 832 in the foregoing manner cancreate a loop section 840 that can engage an outer surface 842 of thewall 810. In various aspects, the loop section 840 can provide a stopthat fixes a section of the tubular member 802 at the end 816 relativeto the loop section 840. Next, the ends 830, 832 can be passed togetherin the second side through aperture 824, guided through the passage 812,and passed out the first side together through the aperture 824. Theends 830, 832 can be passed together through the apertures 822, and 820,in that order, in a similar manner as just described relative to theaperture 824.

In an untensioned state, the anchor 800 can have an accordion firstshape as shown generally in FIG. 12. The anchor 800 can deform from thefirst shape to an accordion second shape as shown in FIG. 13 forming ananchoring mass 850 by tensioning the suture member 804. Tension in thesuture member 804 can be created by pulling on the ends 830, 832.Tension in the suture member 804 can draw the apertures 820, 822, 824towards the apertures 826, 828, and can compress the tubular member 802to create a series of folded sections 860, 862, 864 as shown in FIG. 13.

With additional reference to FIG. 13, an exemplary method of securingthe anchor 800 with a bone 870 according to the present disclosure willnow be described. The method can include securing the anchor 800 withina region of cancellous bone tissue 872 adjacent a region of corticalbone tissue 874. The method can be used during a surgical procedure forcoupling adjoining anatomy such as a soft tissue 875 to the bone 870.

The method can include positioning the anchor 800 in a bore 876 preparedin a selected area of the bone 870 and tensioning the suture member 802to set the anchoring mass 850 within the cancellous bone tissue 872 asshown in FIG. 13. During setting, the folded sections 860, 862, 864 andsections at the ends 816, 818 can frictionally engage and/or expandbeyond the bore 876 and can become embedded in the cancellous bonetissue 872. With the anchoring mass 850 set, the ends 830, 832 can bepassed through the soft tissue 875 and can be coupled to the soft tissue875 by, for example, a suturing technique. When coupled, tension in thesuture member 802 can compress the soft tissue 875 against the bone 870.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

What is claimed is:
 1. A method of securing an anchor to tissue,comprising: determining an area of the tissue to couple an anchor,wherein the anchor includes: (i) a flexible first tubular memberincluding a first wall defining a first passage between first and secondends, (ii) a flexible second tubular member including a second walldefining a second passage between first and second ends, and (iii) afirst suture member passing through the first wall and the first passageand the second wall and the second passage; positioning the anchor at aposition relative to the area; and tensioning the first suture memberuntil the first tubular member engages the second tubular member, andthe first flexible tubular member and the second tubular member deformto form an anchoring mass.
 2. The method according to claim 1, whereinpositioning the anchor relative to the area includes positioning theanchor in an aperture formed in the tissue.
 3. The method according toclaim 2, wherein positioning the anchor in the aperture includescoupling an insertion instrument to at least one of the first tubularmember or the second tubular member.
 4. The method according to claim 2,wherein the tissue is a bone and further comprising: passing the firstsuture member through a soft tissue; and coupling the first suturemember to the soft tissue.
 5. The method according to claim 1, whereinthe tissue is a bone and wherein positioning the anchor relative to thearea includes positioning the anchor relative to a major surface of asoft tissue.
 6. The method according to claim 5, further comprising:engaging the anchoring mass with the major surface; passing the firstsuture member through the soft tissue; and coupling the first suturemember to the bone.
 7. The method according to claim 1, whereintensioning the first suture member includes pulling on the first suturemember adjacent ends of the first suture member.
 8. The method accordingto claim 1, wherein the anchor remains substantially at the positionwhile tensioning the first suture member.
 9. The method of claim 1,wherein the first suture member passes through the first wall and firstpassage and the second wall and the second passage a plurality of timesto form a first loop and a second loop, the first loop couples the firstend of the first tubular member and the first end of the second tubularmember, and the second loop couples the second end of the first tubularmember and the second end of the second tubular member.
 10. The methodof claim 1, wherein the first tubular member and the second tubularmember have a braided construction.
 11. The method of claim 1, whereinthe anchoring mass has a locking configuration.
 12. The method of claim1, wherein tensioning the first suture member until the first tubularmember engages the second tubular member includes deforming each of thefirst tubular member and the second tubular member from a first shape toa second shape.
 13. The method of claim 1, wherein: the first suturemember intersects first sections of the first tubular member and secondsections of the second tubular member, and the first sections engage thesecond sections upon tensioning the first suture member.
 15. The methodof claim 1, wherein the first tubular member extends substantiallyparallel to the second tubular member.
 16. The method of claim 1,wherein the first suture member forms a loop extending between theflexible first tubular member and the flexible second tubular member.17. A method of securing an anchor to tissue, comprising: positioningthe anchor in an area of the tissue, the anchor including (i) a firstflexible member including a first wall extending between first andsecond ends, (ii) a second flexible member including a second wallextending between first and second ends, and (iii) a first suture memberconnexting the first flexible member to the second flexible member;tensioning the first suture member until the first flexible memberengages the second flexible member; and deforming each of the firstflexible member and the second flexible member from a first shape to asecond shape until the first flexible member and the second flexiblemember form an anchoring mass.
 18. The method according to claim 17,wherein tensioning the first suture member includes pulling on the firstsuture member adjacent ends of the first suture member.
 19. The methodof claim 17, wherein the first suture member passes through the firstwall and a first passage of the first flexible member and the secondwall and a second passage of the second flexible member a plurality oftimes to form a first loop and a second loop, the first loop couples thefirst end of the first flexible member and the first end of the secondflexible member, and the second loop couples the second end of the firstflexible member and the second end of the second flexible member.
 20. Amethod of securing an anchor to tissue, comprising: inserting aninstrument carrying an anchor having a first flexible member separatedfrom a second flexible member into the tissue; and tensioning a suturemember coupled to the first flexible member and the second flexiblemember to draw the first flexible member toward the second flexiblemember and into engagement to change the anchor from a firstconfiguration to a second configuration to form an anchoring mass. 21.The method of claim 20, wherein inserting the instrument carrying theanchor further includes inserting the instrument into a bore formed intobone.
 22. The method of claim 21, further comprising attaching thesuture member to soft tissue to secure the soft tissue to the bone. 23.The method of claim 20, wherein inserting the instrument furtherincludes inserting the instrument wherein the first flexible member isattached to a first portion of the instrument and the second flexiblemember is attached to a second portion of the instrument spaced apartfrom the first portion to carry the anchor into the tissue with thefirst flexible member separated from the second flexible member.
 24. Themethod of claim 20, wherein tensioning the suture member furtherincludes tensioning the suture member that is coupled to the first andsecond flexible members by two suture loops, wherein upon tensioning thesuture member, diameters of the loops are reduced to bring the first andsecond flexible members into engagement.